Enhancement patterns of the normal facial nerve on three-dimensional T1W fast spin echo MRI

OBJECTIVES: With increasing neuroimaging applications of contemporary three-dimensional T(1) W fast spin echo (3D T1W FSE) sequences, it was aimed to reappraise the normal patterns of skull base facial nerve gadolinium enhancement. METHODS: Pre- and post-gadolinium 3D T1W fast spin echo imaging studies (n = 64) were retrospectively analysed in patients without suspected facial nerve pathology. Two independent observers scored the signal at each of six skull base facial nerve segments. Wilcoxon signed-rank test was used to compare changes in signal between pre- and post-gadolinium sequences at each location, and how this differed between proprietary sequences or between the pairs of facial nerves. RESULTS: There was significant enhancement at the fundal canalicular (16%), geniculate ganglion (96%), tympanic (45%) and mastoid (38%) facial nerve segments (p < 0.05). Two different proprietary sequences demonstrated similar patterns of enhancement and there was symmetry between the two sides. CONCLUSIONS: There is a differing pattern of normal facial nerve enhancement on contemporary 3D T1W FSE sequences compared to previous studies of 2D T1W SE imaging and fundal canalicular enhancement may be physiological. ADVANCES IN KNOWLEDGE: This is the first study to evaluate patterns of normal facial nerve enhancement using contemporary 3D T1W FSE MRI sequences.